METABOLIC SYNDROME, INCIDENCE OF DIABETES

AND MORTALITY AMONG ELDERLY: THE ITALIAN LONGITUDINAL STUDY ON

AGING

M Noale, S Maggi, F Limongi, P Siviero, G Romanato, G CrepaldiCNR, Institute of Neuroscience, Padova (Italy)

MGSD 2011 Casablanca, Morocco

• The Metabolic Syndrome (MetS) is a clustering of metabolic and physiologic disorders, affecting an important part of the Italian elderly population: results from the ILSA study show that it is present in 31.5% of older men and 59.8% of older women.

• Because of its association with insulin resistance, subjects with MetS are more likely to have type 2 diabetes (T2D).

• The aim of the present work is to investigate if MetS can predict incidence of T2D and if it exists a synergic association MetS-T2D and all-cause mortality among elderly subjects.

MATERIAL AND METHODS

• The analyses are based on data collected by the Italian Longitudinal Study on Aging (ILSA):

• Logistic regression models were defined to study the influence of MetS on incidence of T2D, adjusting for age, sex, individual Mets components.

• Data on mortality collected between baseline and 1996 follow-up were considered, and Cox Ph Models defined to determine the death risk attributation to the synergic association of MetS and T2D.

Sample (Maggi et al, 1994) : 5,632 free-dwelling and institutionalised individuals aged 65-84 resident in 8 centers randomly selected from the local anagraphic lists, equal allocation by sex and 5-year-age groups with two phases

Screening phase, with personal interview, laboratory test, and diagnostic tests (MMSE, neurological tests, GDS, ADL, IADL, spirometry, retinography, electrocardiography)

Clinical confirmation by geriatrician or neurologist for those subjects screened positive for heart failure, angina, arrhythmia, hypertension, myocardial infarction, diabetes, stroke, parkinsonism, distal symmetric neuropathy of lower limbs, dementia

MILANO

GENOVA

FIRENZE

PADOVA

FERMO

NAPOLI

CATANIA

BARI

RESULTSINCIDENCE OF DIABETES

Subjects without T2D at baseline(n=2,660)

42,553,1

34,140,6

14,7

89

0

20

40

60

80

100

%

MetS

Abdominal obesity (>102 men; >88 women)

Plasma triglycerides (>=1,69 mmol/L)

HDL (<1.04 mmol/l men, <1.29 women)

Fasting glucose (>=6.1 mmol/l)

Systolic blood pressure (>=130 mm Hg) or diastolic bloodpressure (>=85 mm Hg), or treated with hypertensive

INCIDENT CASES OF DIABETES

(n=68)OR 95% CI p-value

Metabolic syndrome

3.00

1.14-7.85 0.0255

Abdominal obesity

1.50

0.70-3.18 0.2955

Triglycerides 0.57

0.32-1.02 0.0573

HDL cholesterol 0.58

0.31-1.08 0.0842

Fasting Glucose 9.12

4.98-16.7 <0.0001

Blood pressure 1.98

0.41-9.54 0.3954

(model adjusted for age, sex, individual MetS criteria)

RESULTSALL CAUSE MORTALITY

Subjects with or without diabetes at baseline (n=3,081)

Subjects without diabetes and MetS

(T2D- MetS-, n=1,529)

Subjects with diabetes but without MetS

(T2D+ MetS- n=92)

Subjects without diabetes but with MetS

(T2D- MetS+ n=1,132)

Subjects with diabetes and MetS

(T2D+ MetS+, n=328)

ALL CAUSE MORTALITY

(n=297 death)HR 95% CI p-value

T2D – MetS - 1.00 - -T2D + MetS - 2.26 0.95-5.41 0.0661T2D – MetS + 1.13 0.58-2.18 0.7211T2D + MetS

+2.68 1.10-6.55 0.0307

(model adjusted for age, sex, individual MetS criteria, education, smoking status, marital status, hypertension, myocardial infarction, heart failure, angina, ictus, distal symmetric neuropathy, arrhythmia, disability in ADL, disability in IADL)

CONCLUSION

MetS is associated with incidence of T2D, and the synergic association MetS-T2D is an important risk factor for all-cause mortality among elderly subjects.